title: CT for headache: cost/benefit for subarachnoid hemorrhage.
abstract: Nationwide cost and benefit was estimated for performing computed tomography (CT) on headache patients in the hope of discovering a specific finding, subarachnoid hemorrhage. Case finding costs were estimated using a previously published survey of CT use at a university hospital where, of 258 headache patients scanned, two had subarachnoid bleeding due to ruptured aneurysms. The incidence and natural history of ruptured aneurysms from a large-scale clinical trial and the outcome of surgery from the recent literature were used in the calculations. The results ranged from a worst case calculation of $24,713/year and $543,688/person saved (ignoring all other diagnoses) to a best case calculation of $1,999/year and $43,975/person assuming that other positive diagnoses were of equal outcome to ruptured aneurysms. The analysis, using a technique recommended as a model for future determinations of this type, also demonstrated that a most important variable in determining costs is the case finding rate. If there is a need to improve the use of new diagnostic technologies, such as CT, concentration should be on the identification of the characteristics of high-yield patient groups.
mesh_terms: D003362:Cost-Benefit Analysis; D006261:Headache / Q000191:economics* / Q000209:etiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery; D012421:Rupture; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data